Issue link: https://beckershealthcare.uberflip.com/i/593112
69 PRACTICE MANAGEMENT THOUGHT LEADERSHIP border to border, and shame on any party if they move us backward in that regard. Q: What are you most hopeful for or optimistic about in healthcare in the next five years? LN: e quality of care and the overall patient experience is really improving. I think the catalysts that will move that even faster are global payment and accountable care with aligned incentives for the various providers that patients may encounter, not just hospitals. With that focus, consumers are naturally more engaged and activated to improve their health. It's a synergistic strategy. Because more and more hospitals are using risk-based payment across the com- monwealth, we find that providers — es- pecially physicians — find that it's more edifying work. is is facilitating a team approach to care instead of a traditional hierarchical approach, and they're getting better outcomes. Q: What is one of the biggest chal- lenges Massachusetts hospitals are currently facing? LN: e shi to risk-based reimburse- ment has spawned a great deal of consol- idation among hospitals and physician groups, with a strong focus on being more efficient, reducing readmissions and unnecessary care. Inpatient volumes have continued to go down with a greater shi to care being done in ambulatory set- tings, which is good, but that is creating pressure on the workforce. Almost all hospitals here have had layoffs to right- size their organizations to meet these new realities. Labor unions are very threatened by that. One in particular is attempting to intervene through a ballot initiative in an effort to save jobs for their members. e ballot initiative would impose a reg- ulatory pricing framework on hospitals, to shi commercial payments around. is is a dicey issue, because a ballot initiative would raise the level of regulation and bureaucracy, which most of our members see as counter-productive as they attempt to shi away from fee-for-service. While some hospitals naturally want better com- mercial payment, all of them are opposed to a ballot-driven approach. Q: What is unique about Massa- chusetts? What must healthcare executives in the commonwealth factor more into their strategies than they would if they were locat- ed elsewhere in the country? LN: Massachusetts is unique because most of our care is delivered in teaching hospitals, which are inherently more expensive. Nearly 46 percent of all patient days in Massachusetts are in teaching hos- pitals, while nationally that average is 19 percent. Since we do have more teaching hospitals per capita, patients tend to select them over local community hospitals, and this creates tension between some com- munity hospitals and teaching institutions unless they are all in the same system. Another factor that makes us unique is we have boatloads of transparency. ere's a state agency that monitors, in great de- tail, the cost of healthcare from total med- ical expense down to a provider level. We passed a law that sets a healthcare cost growth ceiling, and that ceiling is designed to align the cost growth of care to the growth of the economy. For the last several years, our growth trend has been well be- low our target of 3.6 percent growth for to- tal medical expenses. However, in 2014 it went above that rate. What's driving that is primarily spending on the Medicaid pop- ulation due to a failed state exchange issue and the growth of pharmaceuticals and drug costs. It's not driven by hospital care or the cost of stay. We are doing a good job of bringing those down, but other factors are driving it up. e hospitals will have to respond to that. Q: What is your strategy for build- ing a team? What does an ideal team or support system look like to you? LN: I like to make almost all decisions with the full team's involvement. I let them be part of the process to consensus on a particular direction, which helps ensure buy-in. I like to assign projects that require team effort and leave it up to them to figure out how to achieve the expected outcome. I don't step in unless they ask questions or for help. I've found my team finds great satisfaction working with those they wouldn't normally work with and building bonds. An ideal team is one where each mem- ber is full of new ideas. ey're always challenging the status quo and thinking of new ways to do something that's historical- ly been done one way. I have no tolerance for nonperform- ers. e challenges in healthcare are too heavy to tolerate people who can't per- form. If they can't keep up with our pace, culture and work with a team, they aren't a good fit. Q: How do you deal with naysay- ers and resistance to change? LN: I am a change agent inherently. My entire career has been driven by my desire and success at being a change agent. I have little tolerance for naysayers and people who want to maintain the status quo. While I don't want groupthink or people who just say 'yes' to everything, if someone is always negative or resistant to change, I don't make the investment to bring them along. ere is too much work to do, too many priorities and too many great people in healthcare to waste time on people who drag everyone else down. Q: What is the most memorable piece of advice you've ever re- ceived? LN: I hear and read a lot about what my hospitals are doing, but I'm not personally in the bowels of the hospital anymore. One piece of advice that really hit home with me came from a hospital CEO. She said, 'You don't know what you don't know.' I really took that to heart because healthcare is so complex that you have to consider many perspectives. I try hard to listen, learn, ask a lot of questions and get a lot of input from others before making decisions. However, ultimately it's up to the leader to execute — you don't want 'paralysis by analysis.' n